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Objective To investigate the etiology,diagnosis and treatment of the delayed gastric emptying after abdominal surgery.Methods From January 2005 to December 2012,the clinical data on diagnosis and treatment of 32 cases of delayed gastric emptying after abdominal surgery were retrospectively analyzed.Results Delayed gastric emptying occurred in 32 cases after 5-8 days after the surgery,which accounted for 40.63％ of gastric surgery.Blood loss was 100-300 mL in 15 cases,9 cases' blood loss was more than 350 mL,accounting for 75％.Thirty cases were cured by conservative treatment,accounting for 93.75％,2 cases on the 20th day after surgery and the 31 th day after surgery to accepted surgery again,accounting for 6.25％.Conclusion The delayed gastric emptying after surgery is closely related to surgical site,methods and surgical sub-injury.Non-occurrence of surgical treatment is the main method to cure this disease.
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Objective To investigate the expression of multidrug resistance protein such as multidrug resistance-associated protein 1 (MRP1),lung-resistance related protein (LRP), P-glycoprotein (Pgp),glutathione s-transferase (GST-π) and topoismerase Ⅱ (TOPO Ⅱ ) in hepatocellular carcinoma (HCC), which would be supplied for the clinical chemotherapy of HCC. Methods Twenty-six cases of HCC who underwent hepatectomy were enrolled and immunohistochemical (IHC) staining was carried out on all specimens for the detection of expression of MRP1,LRP,Pgp,GST-πand TOPO Ⅱ and the data was analyzed by image analysis system. Results The expression of five multidrug resistance protein in HCC tissue were significantly higher than those in adjacent tissue beyond cancer (P ＜0.05). The significant differences were found in the expression of Pgp,TOPO Ⅱ and GST-π between HCC tissue and distant metastasis (P ＜ 0.05 ). The expression of the five multidrug resistance protein in poorly differentiated HCC tissue was higher than that in well-differentiated tissue,while the significant difference was only found in the expression of TOPO Ⅱ (P ＜ 0.05 ). The significant association was not found between the expressions of five multidrug resistance protein in HCC tissue and the size of tumor,AFP, the portal vein tumor thrombus,hepatic cirrhosis and liver function. Conclusions Five multidrug resistance protein overexpression in various degrees in HCC tissue, which relates to some biological behavior of the cancer. Combined detection is of much benefit to the choice of the drug of chemotherapy and to the prediction of prognosis.
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ObjectiveTo investigate the effectiveness of combined oxaliplatin regimen as adjuvant chemotherapy for hepatocellular carcinoma and to evaluate the efficacy of using adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) for direction of individual chemotherapy.MethodsThe twenty-six patients with primary hepatocellular carcinoma were operated.Specimens were collected and adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) was applied to evaluate the sensitiveness of chemotherapy agent(Adriamycin, Mitomycin, Mitoxantrone, Oxaliplatin, Irinotecan, 5-FU, Gemzar, Carboplatin, Cisplatin, Docetaxel and Etoposide).Sensitive group (SG) was from from 11 patients who were sensitive to oxaliplatin, and control group was from the other 16 patients who were not sensitive to oxaliplatin.All the twenty-six patients received oxaliplatin combined with 5-FU or capecitabine regimen chemotherapy.The effectiveness (CR,PR,SD,PD,ORR,OS and DFS) of the regimen according to RECIST criteria and WHO criteria for anticancer drugs toxicity and efficacy of ATP-TCA were evaluated.ResultsTwenty-six patients were successfully evaluated.In SG, six patients obtained complete remission(CR), three got partial remission(PR), one got stable disease (SD) and one patient got progression disease (PD).While in control group,four patients obtained CR,two patients got PR, five patients got SD and four got PD.No significant differences were found in overall survival (OS, P = 0.1116) and disease-free survival (DFS, P = 0.2328)between sensitive group and control group.But significant differences were found in overall response rate (ORR) (81.8％ vs 40.0％, P =0.0401) between two groups.Common toxicities were as follows:I to Ⅱdegree of myelosuppression was 53.8％, I to Ⅱ degree of gastrointestinal tract response was 50％, I to Ⅱ degree of liver function damage was 57.7％ and I to Ⅱ degree of neuropathy was 23.1％, respectively.Most of these toxicities were tolerable at grade 1 ～ 2.No significant differences were found in the toxicities between two groups.ConclusionsCombined oxaliplatin regimen might be an effective choice for adjuvant chemotherapy for HCC, which has with tolerable systemic toxicity.Application of ATP-TCA system might further improve the efficacy of this regimen by selecting right candidate.
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BACKGROUND: Extensive liver resection or liver transplantation operated on patients with combined hepatic cirrhosis and other complications correlates with high morbidity and mortality.Child-Turcotte-Pugh scoring system is now widely used in the assessment of liver function.This classification scheme includes three clinical indicators and two biochemical indices;however,it seems difficulty on directly evaluating functional status of hepatocytes.OBJECTIVE: To explore the practicability of bioluminescence adenosine triphosphate (ATP) determination assay to assess the functional reserve of residual hepatocytes,DESIGN,TIME AND SETTING: Case contrast study,which was carried out in the Second Affiliated Hospital,Sun Yat-sen University from January 2005 to March 2006.PARTICIPANTS: Thirty-two patients who underwent major extra-and intra hepatic surgery including liver transplantation were randomly divided into three groups based on hepatic cirrhosis grading standard,including normal group (n=7),macronodular cirrhosis group (n=9),and micronodular cirrhosis group (n=16).METHODS: Routine examination and biochemical indexes of liver were performed preoperatively,including glutamic oxalacetic transaminase (GOT) and total bilirubin (TBIL).Liver specimens were delivered by aseptic technique during operation and enzymatic digested.Cell suspension was cultured and centrifuged.Hepatocytes were counted and dispensed cell suspension to be used for ATP extraction and measurement.MAIN OUTCOME MEASURES: ATP content,preoperative biochemical parameters of liver function,and correlation between biochemical parameters and ATP content.RESULTS: The ATP content in the macronodular cirrhosis group was significantly higher than that in the micronodular cirrhosis group and normal group (P=0.000 1,0.004).While,the ATP content in the micronodular cirrhosis group was also significantly higher than that in the normal group (P=0.004).ATP content (mole/cell) wassignificantly positively correlated with serum glutamic oxalacetic transarninase (r=-0.609 3,P=0.000 2) and TBIL (r=0.614 5,P=0.000 2).CONCLUSION: ATP assay can directly evaluate functional reserve of liver parenchyma and reflect high operative risk status (HORS) and course of postoperative recovery in major hepatic resection.